Some ICU patients can develop psychosis

LifeBridge Health, Baltimore Sun

Dr. Chaitanya Ravi

Dr. Chaitanya Ravi (LifeBridge Health, Baltimore Sun)

Meredith Cohn, The Baltimore Sun

With all of the beeping of machines and checking of vital signs, patients in the intensive-care unit often have trouble sleeping. This, along with other hospital conditions, like lack of natural light and familiar surroundings, can lead to disorientation. It's called ICU psychosis, and while it's unsettling to patients and their families, it's not likely to last all that long, according to Dr. Chaitanya Ravi, director of LifeBridge Health Hospitalist Services.

What is ICU psychosis and what are the main symptoms of it?

ICU psychosis is a change in the mental health status of a patient who is being treated in an intensive care unit when there is no biological reason for it.

The main symptoms of it can include delirium, hallucinations, disorientation, agitation — which can result in someone trying to pull out a catheter or an IV line — or even hearing voices.

Because many of these symptoms can be indicators of other conditions, such as stroke, low blood sugar, hypothyroidism, and/or drug or alcohol intoxication, just to name a few, the diagnosis of ICU psychosis is made by excluding other possible causes through medical histories and testing.

Who typically may have an ICU psychosis episode and what can cause it?

Anyone can have an incident of ICU psychosis, but the elderly, frail and patients who are in the ICU for long periods of time are more likely to be affected by it than those patients who are able to be discharged quickly.

ICU psychosis can be caused by a variety of different factors. Because the environment in an ICU is unlike the outside world, it can sometimes cause some sensory deprivation. For instance, there is usually low lighting in the rooms to create a serene feeling, and the windows often don't open. Together, both of these things can mean if someone is in an ICU for an extended time, he or she may not be getting fresh air or even have a sense of night and day, which could cause confusion and uneasiness.

Not getting enough sleep can also be a big reason that this condition develops. Even if patients were sleeping normally before they were admitted to an ICU, their sleep cycle is often affected quite a bit because their vital signs are must taken regularly and blood work must be done when necessary, day and night.

Other possible explanations can be certain drug interactions, extreme pain, infections and even abnormal electrolytes. Each can weaken the body and, in turn, take a toll on the mind and be responsible for causing an occurrence like this.

How is ICU psychosis treated and how long does it typically last?

The more we learn about ICU psychosis, the more effective we can be with treatments. However, the best way to help patients who have ICU psychosis is to treat the injuries or illnesses that they originally went to the hospital to receive care for and then get them back into the routine of their own lives, in their own homes, as soon as possible.

Medical staff members also keep a lookout for the underlying conditions that can cause people to refuse to eat and drink because when someone becomes dehydrated, that can also lead to ICU psychosis. That's why it is important for patients to listen to dietitians, doctors and nurses when it comes to consuming food and beverages even if they do not always feel like it.

Additionally, all of the medications that patients take while in the ICU are closely monitored because some of them can exacerbate ICU psychosis, such as some steroids, which can cause anxiety and apprehension.

Fortunately, for most patients, once they leave the ICU, their psychosis goes away because the stress is removed, their sleep patterns are normal again and they are in familiar surroundings. However, in extreme cases, ICU psychosis can last as long as two weeks. Sometimes shift workers or nursing home residents have the symptoms longer because of their sleep patterns.

Can ICU psychosis be prevented?

There are several good ways to try to prevent ICU psychosis from happening.

Protect patients' sleeping patterns as much as possible, especially at night. Communicate facts to keep patients in the here and now, such as repeating the date, day of the week and time. Hospital employees also introduce themselves when they come into a room so that they are not strangers. Visit loved ones in the ICU, when allowed, so those patients are surrounded with familiar people. Keeping them up-to-date on outside happenings is also helpful. Make the lights in the room brighter during the day and darker at night to simulate the outside world. Discharge patients as soon as possible.

These may not completely eliminate ICU psychosis all together, but they may minimize the effects.

Are there any long-term effects of having it?

Happily, there are no long-term effects of having an ICU psychosis episode.